Navajo confront death (and end of life care) with poetry

Navajo traditionally believe that death might come from talking about it. This makes the protocol for end of life care—wills, DNR directives, hospice wishes—incredibly difficult for Navajo families. But Mitzie Begay and Dr. Timothy Domer have found success using poetry to work with Navajo elders. The NYT has the story:

The vehicle was a poem: “When that time comes, when my last breath leaves me, I choose to die in peace to meet Shi’ dy’ in” — the creator. Written in both Navajo and English, it serves to open a discussion about living wills and advance directives.

Fewer than 30 percent of Americans have signed advance directives for health care. But Dr. Domer says almost 90 percent of patients in the program have signed the poem and other standard directives.

“Our elders tell us they want to die with dignity — the way they lived,” he said. “We’ve changed how patients live their final days by opening the discussion on death and dying, and giving patients and families the opportunity to tell us what is important to them.

“Before we started this program, the subject was generally avoided out of ‘cultural sensitivity,’ depriving patients and families of preparing for death spiritually, emotionally and practically.”

James S. Taylor, a Navajo scholar, thought that poetry was the perfect way to introduce difficult topics to the culture:

“Using the poem and open-ended questions allows nuanced and respectful solutions to this problem because it gives people the opportunity to discuss end-of-life planning impersonally. It’s a compassionate approach, and it’s in accord with the twin values that Navajos share with mainstream American culture — individual autonomy and personal dignity.”